PROJECT ABSTRACT The overall goal of this NCI K08 proposal is to facilitate Dr. Gita Suneja's development into an independent investigator focused on improving cancer treatment rates and outcomes among HIV-infected cancer patients. Cancer is now the leading cause of non-AIDS death in the HIV population. Cancer survival is significantly worse in people living with HIV compared with the general population, in part because they frequently do not receive appropriate cancer treatment. Dr. Suneja's prior work revealed that oncologists are less likely to offer cancer treatment to HIV-infected patients; however, empiric data on how the diagnosis of HIV affects cancer treatment decision-making by physicians and patients is lacking. The research objectives of this application are to (1) develop a comprehensive understanding of the decision-making process, (2) evaluate the impact of HIV on cancer treatment decision-making, and (3) design a decision support tool for oncologists to promote evidence-based cancer treatment and shared decision-making with HIV-infected patients. The long-term goal is to reduce cancer treatment disparities in the HIV population. To achieve these goals, Dr. Suneja will capitalize on the resources available at Duke University, where she is a faculty member in the Department of Radiation Oncology. Her career development plan incorporates training in mixed methods research, decision- making science, and intervention design - nested within a structured environment of strong multidisciplinary mentorship - that will uniquely position her for an academic career in cancer health services research. In Aim 1 of the proposed study, the investigators will directly observe oncologist-patient interactions to generate a unique and detailed understanding of the cancer treatment decision-making process and the impact of HIV on treatment decision-making. In Aim 2, they will survey a national sample of oncologists identified from the population-based HIV/AIDS Cancer Match Study to systematically identify determinants of cancer treatment decision-making and solicit input on parameters for a clinical decision support tool. Together, data from Aims 1 and 2 will produce detailed and generalizable knowledge on the key elements of the decision- making process that are appropriate intervention targets. In Aim 3, the investigators will utilize a User-Centered Participatory Design framework to develop a clinical decision support tool for oncologists to promote the delivery of evidence-based, patient-centered cancer care to HIV-infected patients. This study will fill a critical void in our understanding of cancer treatment disparities in a population living longer due to effective antiretroviral therapy. In addition, the career development award will provide Dr. Suneja with the analytic training and research deliverables necessary to compete for an R01 award to measure the real world impact of the intervention on cancer treatment rates in the HIV population.